=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659270411
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN MEDICAL JACKSON HOLE URGENT CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2026
-----------------------------------------------------
Last Update Date | 11/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3345 CODY LANE, CODY HOUSE
-----------------------------------------------------
City | TETON VILLAGE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 83025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-485-7116
-----------------------------------------------------
Fax | 307-264-3550
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2050 COYOTE LOOP
-----------------------------------------------------
City | WILSON
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 83014-6700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-485-7116
-----------------------------------------------------
Fax | 307-264-3550
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ ADMINISTRATOR
-----------------------------------------------------
Name | LINDSAY EMERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-726-9432
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------